Provider Demographics
NPI:1205041985
Name:BENEDICTINE LIVING CENTER OF GARRISON
Entity Type:Organization
Organization Name:BENEDICTINE LIVING CENTER OF GARRISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-463-2226
Mailing Address - Street 1:609 FOURTH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540
Mailing Address - Country:US
Mailing Address - Phone:701-463-2226
Mailing Address - Fax:701-463-2910
Practice Address - Street 1:609 FOURTH AVE NE
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-0219
Practice Address - Country:US
Practice Address - Phone:701-463-2226
Practice Address - Fax:701-463-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND845314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility